Medical Student Heersink School of Medicine, University of Alabama at Birmingham
Introduction: Recent studies have highlighted the role of socioeconomic determinants of health on spine surgery outcomes, but the drivers of disparity that underly these observations are unclear. Poor nutrition is known to have adverse effects on lumbar spine surgery outcomes. We hypothesize that residence in a low food access region may be a risk factor for unplanned readmissions following lumbar spine surgery. We sought assess the association of low food access with lumbar spine surgery outcomes.
Methods: We retrospectively reviewed all adult patients at a single institution from 2011 to 2023 who underwent open and minimally invasive lumbar spine surgery using CPT and ICD9/10 codes. Addresses were geocoded and linked with low food access census tracts. Low food access was assigned according to the Health Resources and Services Administration, who designates low food access as census tracts where greater than 100 households have no vehicle and are greater than a half mile from a grocery store. Propensity score matching and multivariate analyses were performed to assess the effect of low food access on readmission rates and complications.
Results: We identified 4284 patients who underwent open or minimally invasive lumbar spine surgery who met the inclusion criteria. The median age at time of operation was 64 [IQR 55 -71] and 15% were African American. The overall 30, 60, and 90-day readmission rate was 2.1%, 3.3%, and 4.1%, respectively. Upon multivariate regression analysis, patients living in low food access regions had higher odds of reoperation within 30 days (OR 1.79, p =0.041) and readmission within 90 days (OR 1.42, p=0.033) after index operation. After propensity score matching by confounders, patients in low food access regions were more likely to be readmitted within 60 days (4.1% vs 2.8%, p=0.037) and 90 days (5.2% vs 3.6%, p =0.023).
Conclusion : Low food access is a risk factor for unplanned readmissions and reoperations following lumbar spine surgery. These results strongly suggest disparities in nutrition access may be an underlying driver of socioeconomic disparities in lumbar spine surgery outcomes. Pre-operative evaluation of a patient’s food access status and post-operative nutritional intervention may improve readmission rates and outcomes.